Female Lung Transplant Recipients Research Articles

Acute Pulmonary Edema After Lung Transplantation: The Pulmonary Reimplantation Response

Although the development of noncardiogenic pulmonary edema or pulmonary reimplantation response (PRR) after lung transplantation has been well described, the incidence has not been established and the relationship of PRR to clinical risk factors has not been analyzed. (1) To describe the incidence of PRR in lung transplant recipients, (2) to identify the predictors of PRR, (3) to examine the correlation of suspected predictors with the severity of PRR, and (4) to evaluate the impact of PRR on morbidity and mortality of lung transplant recipients. Retrospective review of clinical records and radiographic studies. Tertiary care referral center. Ninety-nine consecutive patients with end-stage lung disease undergoing lung transplantation between February 1990 and October 1995. Review of clinical records and postoperative chest radiographs of all lung transplant recipients to identify patients who experienced PRR. Chest radiographs of patients with PRR were graded for severity on a scale of 0 (none) to 5 (very severe). Demographic, pre- and perioperative factors were also evaluated along with short- and long-term survival of patients with PRR. Fifty-six of 99 lung transplant recipients (57%) experienced PRR. The median ischemia time of patients with and without PRR was 168 and 180 min, respectively (p = 0.62). The incidence of PRR was 51% in patients without preoperative pulmonary hypertension, 78% in mild to moderate pulmonary hypertension, and 58% in patients with severe pulmonary hypertension (p = 0.10). Incidence and severity of PRR was similar in patients receiving right, left, or double-lung transplantation. Similarly, age and sex of the recipients and underlying lung disease did not affect the incidence or severity of PRR. The incidence and severity of PRR was higher in patients undergoing cardiopulmonary bypass during lung transplantation. Patients with PRR had prolonged duration of mechanical ventilation and ICU stay. Overall, PRR did not affect the survival of the patients. However, survival of female lung transplant recipients was significantly better than male recipients (median survival, 60 vs 21 months; p = 0.02). Acute pulmonary edema or PRR occurs frequently (57%) after lung transplantation. In this series, PRR was not associated with a prolonged ischemia time, preoperative pulmonary hypertension, the type of lung transplant, underlying lung disease, or age or sex of recipients. However, use of cardiopulmonary bypass during surgery was associated with increased incidence and severity of PRR. Also, the development of PRR resulted in prolonged mechanical ventilation and a longer ICU stay, but did not affect survival. Female lung transplant recipients survived significantly longer than male recipients. The reason for this difference in survival is unclear.

THE NATIONAL TRANSPLANTATION PREGNANCY REGISTRY: PREGNANCY IN FEMALE LUNG TRANSPLANT RECIPIENTS

991 This study analyzes pregnancy outcomes in female lung transplant recipients. Data were obtained through questionnaires, telephone interviews and hospital records. Outcomes of 10 pregnancies in 9 lung recipients included 5 livebirths (mean birthweight [BW] in gms = 2138, mean gestational age [GA] in wks = 34), 4 therapeutic abortions and 1 spontaneous abortion. Of the 5 livebirths, 3 were delivered by Cesarean section. Three infants were severely premature (<32 wks). Neonatal complications occurred in 4 infants as follows: bradycardia with cardiac monitoring for 4 months (GA 31.5, BW 2665), hyaline membrane disease (GA 30, BW 1616), mild hypoglycemia (GA 40, BW 3005), adrenal suppression and necrotizing enterocolitis (GA 30, BW 1077). The mean transplant to conception interval was 2±1.4 yrs (range 0.7-4.7 yrs). Immunosuppressive regimen included 8 cyclosporine (Sandimmune® 7, Neoral® 1) and 2 tacrolimus (Prograf™). During pregnancy 5 recipients had no change in maintenance immunosuppression, 3 had increased dosing, and 1 varied dosing. Maternal comorbid factors during pregnancy included hypertension (n=7 recipients), diabetes (n=1), infection (urinary tract n=1, pneumonia n=1 [pneumocystis carinii at 5 months and aspergillus at 7 months]). There were no cases of pre-eclampsia. Rejections were reported in 4 (40%) pregnancies and were treated with methylprednisolone (3); methylprednisolone and plasmapheresis (1). Of these 4, 2 have reduced graft function and 2 were re-transplanted at 5 and 10 months post-partum, respectively (1 with current function and 1 death at 20 months post re-transplant). The remaining 5 have adequate lung function. There were no neonatal deaths or reports of any structural malformations in the newborn. Follow-up of the children (age 0.9 to 5.6 yrs) has shown normal development with no subsequent problems. CONCLUSIONS: When compared to other solid organ recipients, female lung recipients may face higher risks with regard to pregnancy, particularly related to rejection. Whether pre-pregnancy factors can help to predict which recipients are at risk for adverse outcomes requires further study. Supported by grants from Sandoz, a Division of Novartis Pharmaceuticals Corporation, Fujisawa Healthcare, Inc., and Roche Laboratories, Inc.

HLA ALLOANTIBODIES IN LUNG TRANSPLANTATION

685 There have been numerous reports describing risk in kidney and heart transplantation associated with anti-HLA antibodies in the recipient. In lung transplantation this issue is less clear, perhaps because lung patients are less likely to be presensitized. We examined 147 lung transplants, 75 males and 72 females, performed at this institution to examine whether or not HLA sensitization influenced outcome. Lymphocytotoxic T cell PRA's (CPRA) were generally low with only 11 patients (7.5%) having a PRA>10%. We also examined the patients pre-transplant (pre-TX) sera using a more sensitive flow cytometric method (FPRA) that utilized purified HLA class I antigens attached to beads (FlowPRA I, One Lambda Inc.). Using this methodology, more females (43.1%) had FPRA's>10% than males (26.7%, p=0.04). In addition, 7 females (13.2%) and 5 males (8.5%) had positive retrospective T cell flow cytometric crossmatches (FCXM). One year actuarial graft survivals are shown in the table.TableCPRA's >10% did not influence outcome overall or in males, however sensitized females had 30% lower graft survival than did nonsensitized females. The FPRA methodology did not predict outcome. A positive pre-TX FCXM was associated with lower survival only in females. Post-TX FCXM results were available in 58 patients. Again a positive reaction was associated with lower graft survival in only female patients. While the relatively small number of transplants studied prevents drawing definitive conclusions, it does seem that HLA sensitization does have a negative impact on outcome at least in female lung transplant recipients. As it is often difficult to obtain pre-TX crossmatches, approaches to desensitize female patients pre-TX might diminish the risk.

Donor cerebral tissue pulmonary emboli in a functioning transplanted lung

Cerebral tissue pulmonary embolus (CTPE) is a rare event following severe blunt or penetrating head trauma and is often complicated by coagulation disturbances and hemorrhage. Donor cerebral tissue pulmonary embolism has been reported to cause lethal, early graft dysfunction in lung transplant recipients. We report a case of donor cerebral tissue pulmonary embolism in a 41‐year‐old female single lung transplant recipient with excellent post‐operative graft function.

Quality of Life in Female Lung Transplant Candidates and Recipients

Quality of life (QOL) studies of lung transplant recipients indicate that there are improvements following transplantation. More recently, there has been some suggestion that certain QOL issues are different for men and women. The purpose of the present study was to examine changes in QOL, body satisfaction, and sexual functioning in women lung transplant recipients. Seven prelung transplant (PRE) and 34 postlung transplant (POST) women. The RAND-36 Health Survey, Body Cathexis Scale, Derogatis Sexual Functioning Inventory, Hospital Depression and Anxiety Scale, Rosenberg Self-Esteem Scale, and an open-ended questionnaire. Higher scores were found in the POST group with respect to general health and role limitations due to physical health. We were unable to detect significant differences between the groups with respect to emotional well-being, role limitations due to emotional health, and social functioning. There were significant differences between the PRE and the POST body satisfaction scores. Although there was no significant difference in overall sexual functioning, recipients in the PRE group reported higher sex drive. Eleven of the POST recipients (52%) scored below the 10th percentile in overall sexual functioning. Overall QOL improves following lung transplantation; however, the lack of differences in many domains of QOL raises the concern that women lung transplant recipients may continue to have significant impairments, including those regarding sexuality and body satisfaction.